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Diffusion of cholera and other diarrheal diseases in an informal settlement is a product of multiple behavioral, environmental and spatial risk factors. One of the most important components is the spatial interconnections among water points, drainage ditches, toilets and the intervening environment. This risk is also longitudinal and variable as water points fluctuate in relation to bacterial contamination. In this paper we consider part of this micro space complexity for three informal settlements in Port au Prince, Haiti. We expand on more typical epidemiological analysis of fecal coliforms at water points, drainage ditches and ocean sites by considering the importance of single point location fluctuation coupled with recording micro-space environmental conditions around each sample site. Results show that spatial variation in enteric disease risk occurs within neighborhoods, and that while certain trends are evident, the degree of individual site fluctuation should question the utility of both cross-sectional and more aggregate analysis. Various factors increase the counts of fecal coliform present, including the type of water point, how water was stored at that water point, and the proximity of the water point to local drainage. Some locations fluctuated considerably between being safe and unsafe on a monthly basis. Next steps to form a more comprehensive contextualized understanding of enteric disease risk in these environments should include the addition of behavioral factors and local insight.

Although studies have shown that human migration is one of the risk factors for the spread of drug-resistant organisms such as methicillin-resistantStaphylococcus aureus(MRSA), surveillance studies examining MRSA among refugee populations in the US are lacking. This study aimed to assess the prevalence and molecular characteristics ofS. aureusamong Bhutanese refugees living in Nepal and resettled in Northeast Ohio (NEO). One hundred adult Bhutanese refugees from each geographic location were enrolled between August 2015 and January 2016. The participants were interviewed to collect demographic information and potential risk factors for carriage. Nasal and throat swabs were collected for bacterial isolation. AllS. aureusisolates were characterized byspatyping and tested for the presence of Panton-Valentine leukocidin (PVL) andmecA genes; selected isolates were tested by multilocus sequence typing (MLST). The overall prevalence ofS. aureuswas 66.0% and 44.0% in NEO and Nepal, respectively. In Nepal, 5.8% (3/52) of isolates were MRSA and 1.1% (1/88) in NEO. Twenty-one isolates in NEO (23.9%) were multidrug-resistantS. aureus(MDRSA), while 23 (44.2%) in Nepal were MDRSA. In NEO, 41spatypes were detected from 88S. aureusisolates. In Nepal, 32spatypes were detected from 52S. aureusisolates.spatypes t1818 and t345 were most common in NEO and Nepal, respectively. The overall prevalence of PVL-positive isolates amongS. aureusin Nepal and NEO was 25.0% and 10.2%. ST5 was the most common sequence type in both locations. Bhutanese refugees living in Nepal and resettled in NEO had high prevalence ofS. aureusand MDRSA.The findings suggest a potential need for CA-MRSA surveillance among the immigrant population in the U S and among people living in Nepal, and a potential need to devise appropriate public health measures to mitigate the risk imposed by community-associated strains ofS. aureusand MRSA.

Informal settlements pose a continuing health concern. While spatial methodologies have proven to be valuable tools to support health interventions, several factors limit their widespread use in these challenging environments. One such technology, spatial video, has been used for fine-scale contextualized mapping. In this paper, we address one of the limitations of the technique: the global positioning system (GPS) coordinate error. More specifically, we show how spatial video coordinate streams can be corrected and synced back to the original video to facilitate risk mapping. Past spatial video collections for the Mathare informal settlement of Kenya are used as an illustration as these data had been previously discarded because of excessive GPS error. This paper will describe the bespoke software that makes these corrections possible, and then will go on to investigate patterns in the coordinate error.

Equitable access to the COVID-19 vaccine remains a public health priority. This study explores the association between ZIP Code–Tabulation Area level Social Vulnerability Indices (SVI) and COVID-19 vaccine coverage in Texas. A mixed-effects, multivariable, random-intercept negative binomial model was used to explore the association between ZIP Code–Tabulation Area level SVI and COVID-19 vaccination coverage stratified by the availability of a designated vaccine access site. Lower COVID-19 vaccine coverage was observed in ZIP codes with the highest overall SVIs (adjusted mean difference (aMD) = −13, 95% CI, −23.8 to −2.1, p < 0.01), socioeconomic characteristics theme (aMD = −16.6, 95% CI, −27.3 to −5.7, p = 0.01) and housing and transportation theme (aMD = −18.3, 95% CI, −29.6 to −7.1, p < 0.01) compared with the ZIP codes with the lowest SVI scores. The vaccine coverage was lower in ZIP Code–Tabulation Areas with higher median percentages of Hispanics (aMD = −3.3, 95% CI, −6.5 to −0.1, p = 0.04) and Blacks (aMD = −3.7, 95% CI, −6.4 to −1, p = 0.01). SVI negatively impacted COVID-19 vaccine coverage in Texas. Access to vaccine sites did not address disparities related to vaccine coverage among minority populations. These findings are relevant to guide the distribution of COVID-19 vaccines in regions with similar demographic and geospatial characteristics.